Please complete and submit this form to let us know how we can assist you or to share a comment or suggestion. Thank you

First Name: *

Last Name: *

Address: *

Address - 2nd line:

City: *

Province or Territory: *

Postal Code: *

Country: *

Phone Number: *

Email Address: *

I would like assistance with the following: *

If this is a patient information or patient services inquiry, are you a:

Patient

Newly diagnosed patient (less than 6 months)

Survivor

Family member

Caregiver

Friend

Health care provider

If you are a patient, please indicate date of diagnosis:+

How can we assist you?

0/255 characters

The Leukemia & Lymphoma Society of Canada (LLSC) is a voluntary health agency dedicated to blood cancers. We also provide free information and support services to patients and caregivers. The LLSC mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families.